Provider Demographics
NPI:1265968895
Name:OUT, JILLIAN (MA)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:OUT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 CEDAR LN APT 152
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1498
Mailing Address - Country:US
Mailing Address - Phone:734-778-2410
Mailing Address - Fax:
Practice Address - Street 1:15817 CRABBS BRANCH WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-6613
Practice Address - Country:US
Practice Address - Phone:301-948-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0526101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor